Cardiac axis

To determine the cardiac axis you need to look at leads I,II and III.

In normal cardiac axis:

Lead II has the most positive deflection compared to Leads I and III

In right axis deviation:

Lead III has the most positive deflection and Lead I should be negative

This is commonly seen in individuals with right ventricular hypertrophy,

Anterolateral MI

In left axis deviation:

Lead I has the most positive deflection

Leads II and III are negative

Left axis deviation is seen in individuals with heart conduction defects,

Ventricular

tachycardia, Inferior MI, Left ventricular hypertrophy and Left Anterior

hemiblock

and Left eft Posterior Hemiblock.

(hindi)

As a general rule if the net deflections in leads I and

aVF are positive then the axis is normal.
If lead I has a net negative deflection whilst aVF is positive then there is
right axis deviation.
If lead I has a positive deflection and aVF has a negative deflection then
there is left axis deviation (oxford)
Right Axis Deviation
Left Axis Deviation

P waves
In some cases there can be a notched (or bifid) p-wave known as p mitrale, indicative of
left atrial hypertrophy which may be caused by mitral stenosis.

Normal Sinus Rhythm ,2. Left Atrial Enlargement with P-mitrale pattern ,3. Left Bundle
Branch Block, 4. First Degree AV Block ,5. Premature Ventricular Contractions
 There may be tall peaked p-waves. This is called p-pulmonale and is indicative of right
atrial hypertrophy often secondary to tricuspid stenosis or pulmonary hypertension.

A similar picture can be seen in hypokalaemia (known as pseudo p-pulmonale).

Causes of a wide QRS:

Bundle branch blocks (LBBB or RBBB)

Hyperkalaemia

Paced rhythm
Ventricular pre-excitation (e.g. Wolf Parkinson White)
Ventricular rhythm
Tricyclic antidepressant (TCA) poisoning
The QRS is tall in left ventricular hypertrophy (LVH)

The criteria suggestive of LVH on the ECG is if the height of the R wave in V6 + the
depth of the S wave in V1. If this value is >35mm this is suggestive of LVH.

ST:
ST elevation indicates infarction.
ST depression is normally due to ischaemia.

ST segment depression may also be seen in digoxin toxicity. Here the ST depression
will be downsloping (sometimes known as the reverse tick sign).
https://lifeinthefastlane.com/ecg-library/digoxin-effect/
T wave
Bundle branch block
Right bundle branch block (RBBB)
RBBB may be a normal variant especially if the pattern is present but with a normal
QRS duration.
o Otherwise it may indicate problems with the right side of the heart.
In RBBB you will see wide complexes with a RSR pattern in V1 and deep S wave in
V6.

Ieft bundle branch block

LBBB you will see wide complexes with a negative

(sometimes W shaped) complex in V1 and an M
pattern in V4 -V6 and T wave inversion in the
anterolateral leads.
Questions and answers
http://www.oxfordmedicaleducation.com/ecgs/ec
g-examples/